On sports radio. In between Instagram posts. Every 15 minutes during a podcast. More and more of our male patients tell us that they are being inundated with ads for testosterone testing, men’s clinics or cures for “low-T” symptoms. If you’re a man over 29, you’ve likely experienced the steady stream of TRT clinics, before-and-afters and “optimize your T” videos.

There is a lot of “buzz” out there regarding testosterone therapy — & for good reason. TRT can be quite effective for men with clinically low testosterone and compatible symptoms. But there’s also a lot of information, misinformation and hollow “marketing” out there that can muddy the water.

We combine our experiences as healthcare professionals with emerging science research to answer a question that we’re starting to hear from our women patients, too: “Is every man on TRT right now?“

Why Is Testosterone Therapy Becoming More Popular?

A few simultaneous factors contribute to the rise in testosterone therapy interest:

• Less stigma around men’s health
• More robust research characterizing who benefits (& who doesn’t)
• More convenient ways to take testosterone (topical gels, longer-acting injections, implants)
• Lower barriers to prescription access due to greater telehealth capabilities
• Increased advertising budgets, with popular brands like HIMS & HERS spending $679,000,000 (roughly 46% of their revenue) on marketing in 2024

“You’re also seeing more success stories on Reddit & social media. Men get together online to talk about their symptoms, labs & what works best. The published research is giving a good ‘baseline’ of education. So, guys can now focus on what the real-world experience looks like for them.”

-Courtney Gilbert, PA-C

“Is TRT Safe for the Heart?”

Yes, TRT is safe for the heart — with the usual caveats about individual risk. Large contemporary data (the TRAVERSE trial) found TRT non-inferior to placebo for major cardiovascular events in appropriately selected men. Providers continue to monitor for signs such as elevated hematocrit, edema and rare events (e.g., pulmonary embolism or atrial fibrillation, which were numerically higher in some analyses).

“While your comfort is incredibly important to us, we also personalize dosing & the method of administration route for your safety. Finding the optimal minimal effective dose is so important in reducing any potential risk of side effects.”

-Courtney Gilbert, PA-C

“I get this question a lot from my patients & the most honest answer? There’s evidence that suggests, yes, but the cause isn’t crystal clear. One thing is constant — your existing health, lifestyle & those little decisions we make each day matter a lot. Being in good health certainly isn’t going to hurt your testosterone!”

-Courtney Gilbert, PA-C

What Causes Decreased Testosterone?

Testosterone levels tend to decline gradually beginning around age 35, which is a normal, age-related physiologic change. Additional factors that can lead to decreased testosterone include: 

• Excess Weight & Insulin Resistance: Increases aromatase (which converts testosterone into estrogen) & dampens the brain-to-testes signals that drive testosterone production.
• Obstructive Sleep Apnea: Chronically poor sleep fragments the deep sleep where much of testosterone is made; a lack of consistent, good sleep is often tied to weight gain & negative cardiometabolic health.
• Circadian Disruption & Night-Shift Work: Misaligned sleep–wake schedules blunt normal hormone rhythms & are linked with lower T & increased clinical complaints about sexual-function.
• Chronic Opioid Use: Suppresses the HPG axis, which reduces testicular testosterone output.
• Glucocorticoids (cortisone, hydrocortisone, prednisone): Even at modest daily doses, these drugs inhibit testosterone synthesis; with sustained/high doses they can impair Leydig-cell function (& in lab models, promote cell death).
• Hyperprolactinemia or Pituitary Disorders: Elevations in prolactin (or pituitary disease) disrupt GnRH and gonadotropins, lowering testosterone.
• Iron Overload (Hemochromatosis): Excess iron can deposit in the pituitary/testes, damaging hormone signaling & leading to hypogonadism.
• Anabolic-Androgenic Steroid Use or Recent Withdrawal: Exogenous androgens shut down the HPG axis via negative feedback, often dropping sperm counts and native testosterone after cycles.
• Over-Training & Low Energy Availability: Training too hard in the gym without enough fuel tells the body to prioritize recovery over reproduction, which can lower testosterone.

“Getting the tests back & looking at the results — that’s all great, especially if it clearly indicates high or low testosterone. But our job isn’t just to right a prescription & send you off. We identify which causes are potentially relevant for you & correct what’s correctable before or alongside TRT.”

-Courtney Gilbert, PA-C

What If a Man Takes Testosterone but Doesn’t Need It?

Men who take testosterone without a medical indication may experience:

“Reputable clinicians confirm two morning levels, symptoms & root causes before writing a script to prevent this at all costs. My male patients may walk in, saying they want a TRT prescription because they heard these great things — but they don’t actually want to be on another medication if there are more root-cause ways to address their symptoms.”

-Courtney Gilbert, PA-C

Perimenopause. Menopause. These stages aren’t diseases or disorders. They are natural biological transitions that mark a shift in your body’s hormonal rhythm. And while they may bring on a mix of changes, you’re not powerless in the process.

With the right knowledge and care, you can move through this phase with confidence, poise and control. Our practice often starts this process by answering one of the most common patient questions we face: menopause vs. perimenopause: what’s happening with me?

Perimenopause: A Period Of Flux & Inconsistent Discomfort 

Perimenopause is the stage where estrogen and progesterone levels begin to fluctuate in preparation for menopause, often marked by changes in ovulation. Most women enter perimenopause between the ages of 40 and 44, but it can begin as early as your mid-30s.

What You Can Do To Treat Perimenopause Symptoms

• Keep A Symptom Diary: Track your symptoms by date to identify patterns and better guide conversations with your provider
• Prioritize Sleep Hygiene: Aim for 7 – 9 hours of restful sleep by creating a cool, dark, tech-free environment
• Practice Mindful Movement: Walking, yoga or low-impact strength training can ease joint pain, retain strength and improve mood
• Reduce Alcohol & Caffeine: Both of these, in addition to spicy foods, can amplify hot flashes and sleep disruption
• Dietary Support: Focus on protein-rich, nutrient-dense meals to support hormonal shifts and energy levels; don’t forget to eat enough fiber (aim for at least 25 grams per day)
• Get Professional Insight: Partner with a trusted medical provider who can help evaluate whether starting hormone therapy is right for you

“One of the hardest things I have to do? Tell a patient — who is already navigating all of these symptoms & life changes — that they might need to skip that glass of red wine. It’s not easy, but it can make a profound difference.”

-Courtney Gilbert, PA-C | Menopause Treatment Expert 

The Details: What Happens to Hormones During Menopause

Estrogen levels (especially estradiol) drop significantly and remain consistently low. Progesterone production also essentially halts. FSH (follicle-stimulating hormone) and LH (luteinizing hormone) levels rise as the body tries to stimulate ovaries that are no longer responsive. This hormonal shift confirms menopause in lab testing.

• Common Symptoms: Hot flashes, night sweats, mood changes, decreased libido, weight gain, vaginal dryness and memory issues.
• Uncommon Symptoms: Altered taste, tingling extremities, change in body odor, histamine sensitivity, vertigo and electric shock sensations, specifically before a hot flash.

Note: These are similar to perimenopause symptoms but are often more intense and frequent. 

What You Can Do To Treat Menopause Symptoms

• Consider Bioidentical Hormone Therapy: This is the most effective treatment for many menopause-related symptoms
• Keep It Moving: Stay consistent with physical activity (especially strength training) to support bone density, reduce stress and regulate mood
• A Stronger Foundation: Practice pelvic floor exercises or consider pelvic physical therapy to support sexual wellness and prevent incontinence
• Sexual Wellness Matters: Explore vaginal moisturizers or lubricants to ease dryness and discomfort during intimacy
• Nutrition Care: Fuel your body with calcium-rich and anti-inflammatory foods to support bone and heart health
• Emotional Support: Mental health is vital at this stage; cognitive behavioral therapy, mindfulness practices and social support have all been shown to improve therapeutic outcomes

Guide: Treat Menopause Holistically

Why Do Some People Experience Menopause Earlier?

Menopause doesn’t follow a universal timeline. It can vary from patient to patient. Several factors can cause it to begin earlier than expected, including:

• Genetics: Family history plays a major role in when menopause begins
• Medical Treatments: Chemotherapy, radiation or surgery that removes the ovaries can lead to early or sudden menopause
• Lifestyle Choices: Smoking, high chronic stress, low body weight and poor nutrition may accelerate hormonal changes
• Underlying Conditions: Autoimmune diseases or conditions like Addison’s disease can affect hormone production
• Environmental Factors: Endocrine disruptors from plastics or chemicals may also play a subtle role over time

Hormone Therapy: The Most Effective Treatment For Most Symptoms

Hormone therapy (HRT) is increasingly recognized as the gold standard for relieving both perimenopausal and menopausal symptoms. By supplementing your body’s declining hormone levels, HRT can help restore balance physically and emotionally by addressing the root cause of the most common symptoms associated with these transitions.

While it’s not a one-size-fits-all solution, many of our patients have experienced profound mental and physical health benefits from consistent bioidentical hormone replacement therapy (BHRT) — from fewer hot flashes and improved sexual health to sharper mental clarity and more sustainable weight management.

Looking your best isn’t just about treatments and skincare products — it starts with what’s happening inside your body. A welcome byproduct of good health is often a more youthful, vibrant appearance, proving that aesthetics and wellness work in tandem. By following the core tenets of functional medicine and correcting imbalances at their root, you can achieve sustainable results that naturally enhance your appearance.

Weight Loss & Healthy Weight Management

Weight management is about more than just counting calories. It’s about balancing hormones, improving gut health, optimizing metabolism with age and proactively addressing underlying health factors. Certified medical weight loss programs — including physician-guided nutrition plans and weight loss injections (like semaglutide or Ozempic) — help the body regulate appetite and fat storage more efficiently.

“By working with your physiology rather than against it, we can create long-term, natural body composition changes that often promote a leaner look.”

-Courtney Gilbert, PA-C

Reduced Bloating & Inflammation

A flatter stomach and a more defined face often start in the gut. Optimizing digestion and reducing systemic inflammation can reduce uncomfortable bloating, helping you look leaner and more sculpted. Through gut health optimization, custom nutrition plans and stress management techniques, you can support a body that functions and feels the way you want it to.

“Balancing gut bacteria is like managing the highway at rush hour. If everything moves well, we’re good. If we get backed up or have some wrecks, everything is exponentially disrupted — except instead of being late to a soccer game, you end up with hormonal acne or mood swings!”

-Courtney Gilbert, PA-C

Hair Health & Growth

Thinning hair and slow growth often stem from hormonal imbalances, gut dysbiosis, nutrient deficiencies or thyroid dysfunction. Functional medicine addresses these root causes, ensuring your body has the necessary building blocks for thick, strong hair.

Common Deficiencies That Can Cause Hair Loss Include:

The Most Common Midwest Nutrition Deficiencies

Muscle Growth & Long-Term Preservation

The body has specific support needs to build and maintain lean mass. Optimized testosterone levels and insulin sensitivity play key roles in muscle development, strength and recovery. A holistic approach to your health allows you to fine-tune these factors through hormone therapy, targeted nutrition and personalized fitness guidance, ensuring your body builds muscle efficiently while maintaining metabolic health.

Longevity & Anti-Aging

Aging gracefully is about supporting the body’s natural ability to repair, regenerate and perform optimally. Functional medicine employs a vast array of tools to mitigate daily stress, treat chronic illnesses and slow aging at a cellular level. By reducing oxidative stress and supporting metabolic function, you can maintain a sharper mind, a fitter physique and brighter skin for years to come.

“We have so many tools in our toolbox to help patients perform & feel their best at any age! Optimized nutrition, strategic meal timing, hormone therapy & exercise regimens that evolve with your progress — these are just a few ways we can get the job done.”

-Courtney Gilbert, PA-C